Technical aspects of performing lymphoscintigraphy - Optimization of methods used to obtain images

Sentinel node detection is an important part of the clinical management of newly diagnosed melanoma. Now there is a similar or even greater enthusiasm for sentinel node evaluation in patients with breast carcinoma. However, c ontroversies exist regarding the dose, volume, and route of administration. Even the role of lymphoscintigraphy itself, in contrast to using only a ha nd-held gamma probe during surgery for sentinel node detection, is being de bated. Nevertheless, many centers and surgeons find that lymphoscintigraphy images are valuable in the treatment of patients and they use lymphoscinti graphy as a guide during surgery and to confirm the results obtained with t he hand-held probe. Centers just beginning to use lymphoscintigraphy may fi nd the images especially useful. Given this fact, the authors wanted to def ine the practical and technical aspects of performing lymphoscintigraphy in patients with breast cancer and examined various methods for the optimizat ion of the technique of image acquisition. The suggested technique is gener ally free of the controversies noted above and applies to most patients. It includes various maneuvers that aim to improve the rate of sentinel node v isualization using the gamma camera and the accuracy of node detection. The recommendations presented here should prove useful for both those experien ced and for those centers just beginning to use the technique of lymphoscin tigraphy.